Overview

Medical abortion is a procedure that uses medication to end a pregnancy. A medical abortion doesn't require surgery or anesthesia and can be started either in a medical office or at home with follow-up visits to your doctor. It's safer and most effective during the first trimester of pregnancy.

Having a medical abortion is a major decision with emotional and psychological consequences. If you're considering this procedure, make sure you understand what it entails, side effects, possible risks, complications and alternatives.

Why it's done

The reasons for having a medical abortion are highly personal. You can choose medical abortion to complete an early miscarriage or end an unwanted pregnancy. You can also choose to have a medical abortion if you have a medical condition that makes continuing a pregnancy life-threatening.

Risks

Incomplete abortion, which may need to be followed by surgical abortion

An ongoing unwanted pregnancy if the procedure doesn't work

Heavy and prolonged bleeding

Infection

Fever

Digestive system discomfort

You must be certain about your decision before beginning a medical abortion. If you decide to continue the pregnancy after taking medications used in medical abortion, your pregnancy may be at risk of major complications.

Are too far along in your pregnancy. You shouldn't attempt a medical abortion if you've been pregnant for more than nine weeks (after the start of your last period). Some types of medical abortion aren't done after seven weeks of pregnancy.

Can't make follow-up visits to your doctor or don't have access to emergency care.

Have an allergy to the medications used.

A surgical procedure called a dilation and curettage (D&C) may be an option for women who can't have a medical abortion.

How you prepare

If you're considering a medical abortion, meet with your doctor to discuss the procedure. Your doctor will likely:

Evaluate your medical history and overall health

Confirm your pregnancy with a physical exam

Do an ultrasound exam to date the pregnancy and confirm it's not outside the uterus (ectopic pregnancy) and not a tumor that developed in the uterus (molar pregnancy)

Do blood and urine tests

Explain how the procedure works, the side effects, and possible risks and complications

Having a medical abortion is a serious decision. If possible, talk with your partner, family or friends. Talk with your doctor, a spiritual adviser or a counselor to get answers to your questions, help you weigh alternatives and consider the impact the procedure may have on your future.

Keep in mind that no doctor is required to perform an elective abortion and that in some states there are certain legal requirements and waiting periods you must follow before having an elective abortion. If you're having an abortion procedure for a miscarriage, there are no special legal requirements or waiting periods required.

What you can expect

Medical abortion doesn't require surgery or anesthesia. The procedure can be started in a medical office or clinic. A medical abortion can also be done at home, though you'll still need to visit your doctor to be sure there are no complications.

During the procedure

Medical abortion can be done using the following medications:

Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec). This is the most common type of medical abortion. These medications are usually taken within seven weeks of the first day of your last period.

Mifepristone (mif-uh-PRIS-tone) blocks the hormone progesterone, causing the lining of the uterus to thin and preventing the embryo from staying implanted and growing. Misoprostol (my-so-PROS-tol), a different kind of medication, causes the uterus to contract and expel the embryo through the vagina.

If you choose this type of medical abortion, you'll likely take the mifepristone in your doctor's office or clinic. Then you will probably take the misoprostol at home, hours or days later.

You'll need to visit your doctor again about a week later to make sure the abortion is complete. This regimen is approved by the Food and Drug Administration (FDA).

Oral mifepristone and vaginal, buccal or sublingual misoprostol. This type of medical abortion uses the same medications as the previous method, but with a slowly dissolving misoprostol tablet placed in your vagina (vaginal route), in your mouth between your teeth and cheek (buccal route), or under your tongue (sublingual route).

The vaginal, buccal or sublingual approach lessens side effects and may be more effective. These medications must be taken within nine weeks of the first day of your last period.

Methotrexate and vaginal misoprostol. Methotrexate (Otrexup, Rasuvo, others) is rarely used for elective, unwanted pregnancies, although it's still used for pregnancies outside of the uterus (ectopic pregnancies). This type of medical abortion must be done within seven weeks of the first day of your last period, and it can take up to a month for methotrexate to complete the abortion. Methotrexate is given as a shot or vaginally and the misoprostol is later used at home.

Vaginal misoprostol alone. Vaginal misoprostol alone can be effective when used before nine weeks of gestation of the embryo. But vaginal misoprostol alone is less effective than other types of medical abortion.

The medications used in a medical abortion cause vaginal bleeding and abdominal cramping. They may also cause:

Nausea

Vomiting

Fever

Chills

Diarrhea

Headache

You may be given medications to manage pain during and after the medical abortion. You may also be given antibiotics, although infection after medical abortion is rare.

Your doctor will let you know how much pain and bleeding to expect, depending on the number of weeks of your pregnancy. You might not be able to go about your normal daily routine during this time, but it's unlikely you'll need bed rest. Make sure you have plenty of absorbent sanitary pads.

If you have a medical abortion at home, you'll need access to a doctor who can answer questions by phone and access to emergency services. You'll also need to be able to identify complications.

After the procedure

Signs and symptoms that may require medical attention after a medical abortion include:

Heavy bleeding — soaking two or more pads an hour for two hours

Severe abdominal or back pain

Fever lasting more than 24 hours

Foul-smelling vaginal discharge

After a medical abortion, you'll need a follow-up visit with your doctor to make sure you're healing properly and to evaluate your uterine size, bleeding and any signs of infection. To reduce the risk of infection, don't have vaginal intercourse or use tampons for two weeks after the abortion.

Your doctor will likely ask if you still feel pregnant, if you saw the expulsion of the gestational sac or embryo, how much bleeding you had, and whether you're still bleeding. If your doctor suspects an incomplete abortion or ongoing pregnancy, you may need an ultrasound and possibly a surgical abortion.

After a medical abortion, you'll likely experience a range of emotions — such as relief, loss, sadness and guilt. These feelings are normal. It might help to talk to a counselor about them.

Preventing pregnancy

Ovulation usually occurs as soon as two weeks after a medical abortion, and another pregnancy is possible even before your period begins. Before the abortion, talk to your doctor about contraception that you can start as soon as the procedure is over.

American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Gynecology and the Society of Family Planning. ACOG Practice Bulletin No. 143: Medical management of first-trimester abortion. Obstetrics and Gynecology. 2014;143:1.

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